COMPANY DETAILS
Company Name:
Contact Name - Title & Surname:
Contact Name - First Name
Business Address:
Postcode:
Contact Number:
E-mail Address:
BUSINESS DETAILS
Nature of Business:
Example of Customers:
Description of Manufacturing Processes (if applicable):
Details of Products Manufactured:
Number of Years Trading:
Renewal Date:
Target Premium (£):
COVER REQUIRED
Buildings Sum Insured (£):
Is Subsidence Cover Required?
Glass & Signs (£):
Fixtures, Fittings, Plant & Machinery (£):
Stock (£):
Examples of Type of Stock:
Non Ferrous Stock (£):
Computer& Electronic Office Equipment (£):
Optional Extensions:
Stock In Transit (£):
All Risks Cover for Laptops (£):
Glass Cover (£):
Money Cover (£):
Business Interruptions Cover (£):
Any Other Cover Required:
PUBLIC/PRODUCTS LIABILITY
Limit of Indemnity:
Estimated Annual Turnover:
U.K. (£):
E.U. (£):
USA/Canada (£):
Details of Countries Exported to:
EMPLOYERS' LIABILITY
Limit of Indemnity:
Clerical/Managerial Wage Roll (£):
No of Clerical/Managerial Employees:
Manual Wage Roll (£):
No of Manual Employees:
Details of Work Away From Premises:
Additional Information:
Details of Work Outside of U.K.:
STATEMENT OF FACT
Comments
ADDITIONAL INFORMATION
Are the premises protected by a N.A.C.O.S.S. approved alarm?
Is Police Response Operational?
Are the premises protected by CCTV?
Please detail any other security factors:
Details of ALL and ANY claims or losses in the last five years:
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